Study On The Influence Path Of Powerlessness On Quality Of Life In Patients With Venous Leg Ulcer

ObjectivesThe Venous Leg Ulcer Self-Efficacy Tool(VeLUSET)was translated and its reliability was examined to provide a more valid assessment tool for related studies.To explore the relationship and influencing path among powerlessness,self-efficacy,coping mode and quality of life in patients with venous leg ulcer(VLU)based on stress and coping theory,in order to provide scientific basis for formulating targeted clinical interventions.MethodsThe first part is the Chinese version of the scale and the reliability test.After authorization from the original author,the VeLUSET was translated,back-translated,culturally adjusted and pre-investigated according to the Brislin translation model,and the Chinese version of VeLUSET was finally formed.From June to December 2021,convenience sampling was used to select 228 VLU patients from two third-class A hospitals in Tianjin and Qingdao for questionnaire survey.The critical ratio method and correlation coefficient method were used to analyze the items of the scale.The content validity and construct validity were used to test the validity of the scale.Cronbach’s αcoefficient,split-half reliability and test-retest reliability were used to test the scale’s reliability.The second part is influence path study.From February to August 2022,the convenience sampling method was used to select 233 VLU patients in three third-class A hospitals in Tianjin and Qingdao as the survey subjects.The general information questionnaire,Powerlessness Assessment Tool,VeLUSET,Medical Coping Modes Questionnaire,and Venous Leg Ulcer Quality of life Questionnaire were used for the questionnaire survey.Frequency and constituent ratio were used to describe the general data of VLU patients.Mean±standard deviation was used to describe the total score and scores of each dimension of powerlessness,self-efficacy,coping mode and quality of life.Independent sample t-test and one-way analysis of variance were used to describe the differences in the quality of life scores of VLU patients with different characteristics.Pearson correlation analysis was used to describe the correlation among powerlessness,self-efficacy,coping mode,and quality of life.Multiple linear regression analysis was used to analyze the influencing factors of the quality of life.AMOS 24.0 software were used to construct a structural equation model to explore the influence paths among variables,and the mechanism of powerlessness on quality of life was clarified.Results Part 1:1.The Chinese version of the VeLUSET had 30 items and 5 dimensions,including general self-care,daily self-care tasks,normal living,developing expertise,and avoiding trauma.2.The critical values of each item were 7.794～16.560(P<0.001),and the correlation coefficient between each item score and the total score was 0.546～0.823(P<0.001).The item-level content validity was 0.857～1.000,and the scale-level content validity was0.947.Exploratory factor analysis extracted five common factors,and the cumulative variance contribution rate was 70.760%.The overall Cronbach’s α coefficient of the scale was 0.963,the overall split-half reliability of the scale was 0.933.After two weeks,the test-retest reliability was 0.908.Part 2:1.The powerlessness score was(31.21±11.77).Different genders,marital status,monthly income,recurrence,number of ulcers,limbs,wound symptoms,and pain degree had statistical significance in powerlessness score(P<0.05).The self-efficacy score was(205.72±48.27).The self-efficacy scores differed with marital status,monthly income,working status,living conditions,recurrence,wound symptom,pain degree,and duration of the current ulcer.The differences were statistically significant(P<0.05).The scores of confrontation,avoidance,and submission dimension of coping mode were(19.06±6.07),(14.84±4.36)and(10.60±3.12),respectively.2.The total score of quality of life was(65.04±21.48).The results of the univariate analysis showed statistically significant differences in the quality-of-life scores among VLU patients with different marital statuses,number of ulcers,limbs,recurrence,wound symptoms,and pain degree(P<0.05).The results of multiple regression analysis showed that ulcer recurrence,wound symptoms,pain degree,powerlessness,self-efficacy,and confrontation coping mode could jointly explain 70.5% of the variation of quality of life.3.The results of correlation analysis showed that the powerlessness score was negatively correlated with the scores of self-efficacy and confrontation coping mode(r=-0.591,P<0.01,r=-0.626,P<0.01)and positively correlated with the quality of life score(r=0.727,P<0.01).The quality of life score was negatively correlated with self-efficacy and confrontation coping mode(r=-0.675,P<0.01,r=-0.687,P<0.01).4.The structural equation model showed that powerlessness directly affected the quality of life,and self-efficacy and coping mode had a mediating effect between powerlessness and quality of life in VLU patients,accounting for 42.72% of the total mediating effect.Among them,the mediating chain effect of self-efficacy and confrontation coping mode was 9.48%.Conclusions1.The Chinese version of VeLUSET has good reliability,validity,and application value,which can be used to evaluate the self-efficacy level of VLU patients in China.2.VLU patients have a moderate sense of powerlessness.There are correlations among powerlessness,self-efficacy,confrontation coping mode,and quality of life.Powerlessness can directly affect the quality of life of VLU patients,and can also indirectly affect the quality of life of VLU patients through the mediating role of selfefficacy and confrontation coping mode.